Elsevier

Clinical Nutrition

Volume 28, Issue 2, April 2009, Pages 141-146
Clinical Nutrition

Original article
Characteristics of Alzheimer's disease patients with a rapid weight loss during a six-year follow-up

https://doi.org/10.1016/j.clnu.2009.01.014Get rights and content

Summary

Background & aims

Weight loss in Alzheimer's disease (AD) may be either progressive or rapid, with different consequences. The aim of this study was to characterize massive weight loss (≥5 kg over 6 months) during a 6.5-year follow-up.

Methods

395 patients with AD (mean age 75.4 years) were included in a prospective single-centre cohort study (mean follow-up 2.5 years). A standardized gerontologic assessment was performed every six months, including nutritional, neuropsychological, functional, and caregiver burden evaluations, along with recording all intercurrent events before weight loss.

Results

Among the 127 cases of weight loss (in 110 subjects, 27.8% of the population), we identified 60 cases of intercurrent illnesses and 88 cases of behavioral and psychological symptoms of dementia (BPSD) during the six months before weight loss. Three factors were independently associated with rapid weight loss: higher initial weight (HR = 1.06, 95% CI [1.02, 1.08]), higher Prognosis Inflammatory and Nutritional Index (HR = 2.16, 95% CI [1.26, 3.72]) and a higher Cohen-Mansfield agitation inventory score, reflecting BPSD (HR = 1.05, 95% CI [1.01, 1.10]). Cholinesterase inhibitors appeared as protective (HR = 0.33, 95% CI [0.15, 0.73]). Rapid weight loss was predictive of death at 6 months (HR = 3.01, 95% CI [1.73, 5.22]).

Conclusion

BPSD play an important role in rapid weight loss and should be managed effectively. Biological assessment of malnutrition may be warranted.

Introduction

In patients with Alzheimer's disease (AD), weight loss contributes to the alteration of general health, to the frequency and severity of complications, especially infectious, and to a faster loss of independence. It occurs in about 40% of AD cases, including very early stages, before diagnosis is even possible.1

We have previously reported two different modes of weight loss in AD after a one-year follow-up2: a gradual weight loss (4% or more, known as an independent factor of morbidity and mortality in the elderly3), present in one third of the cohort, whose major risk factor was disease severity (assessed by the Reisberg score). Another mode of weight loss, observed in 10% of patients, was rapid (≥5 kg in the first six months); risk factors for this rapid weight loss were an intercurrent event such as an acute disease, hospitalization or a change of living arrangements.

Characterizing weight loss in AD patients may be crucial: indeed, the progressive and irremediable weight loss featured in late-phase dementia is considered a contra-indication to nutritional support, whereas an acute weight loss may benefit from an aggressive nutritional support.4 Also, an early intervention strategy could be implemented in the latter, in order to prevent or at least decrease the loss.5

The main purpose of this study was to characterize this population of AD patients showing a rapid weight loss (defined as the loss of at least 5 kg in 6 months) during a 6.5-year follow-up.

Section snippets

Study design

This was a single-center, prospective cohort study in the hospitals of Toulouse, France, as part of the Etude Longitudinale de Suivi de la Maladie d'Alzheimer (ELSA study), which has followed ambulatory patients with dementia of Alzheimer type since 1994.

Follow-up comprised a 6-monthly evaluation in the daycare hospital and the collection of intercurrent events by telephone from the general practitioners and/or caregivers every three months during 6.5 years after enrollment.

The diagnosis of AD

Population characteristics at inclusion

395 patients were included. These 395 subjects were followed-up for up to 6.5 years with a mean follow-up of 2.5 years. During follow-up, 65 subjects left the study at the request of their family and 86 died (Fig. 1). The characteristics of the population at inclusion in the ELSA study are mentioned in Table 1, and the flow chart of the cohort appears elsewhere.2

Descriptive analysis of the intercurrent events preceding rapid weight loss

137 events were collected in the 6 months before every weight loss higher than 5 kg (Table 2). This event concerned 27.8% of subjects (n

Discussion

In a previous article about the same cohort,2 we described a rapid weight loss over the course of AD; risk factors for this rapid weight loss were an intercurrent event such as an acute disease, hospitalization or a change of living arrangements. Such risk factors were also found over the whole course of the study; these are not surprising, as they are commonly associated with anorexia in the elderly. The prognostic factors on inclusion were less expected: a higher PINI at inclusion was an

Conflict of interest

None declared.

Acknowledgements

This study was supported by a grant from the French Ministry of Health (Programme Hospitalier de Recherche Clinique).

We gratefully acknowledge Mélanie Koning for assistance with the analysis, and Patrice Brocker for their review of the manuscript and much other advice.

SA and BV were responsible for the study concept and design. OG, SA, CC and BV were responsible for the analysis and interpretation of the data. OG, SA, SMS and BV drafted the manuscript. All authors were responsible for the

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